title: Plaque excision in the management of lower-limb ischemia of atherosclerosis and in-stent restenosis with the SilverHawk atherectomy catheter.
abstract: OBJECTIVE
  Aim of the present study was to compare the effectiveness of plaque excision in management of lower limb ischemia of atherosclerosis and in-stent restenosis with the SilverHawk atherectomy catheter.
  
  
  METHODS
  From November 2010, to August 2011, 43 patients were involved and completed follow-up. They were divided into two groups: group A is the atherosclerotic plaque group (16 cases, 37.2%) and group B is the in-stent restenosis/occlusion lesion group (27 cases, 62.8%). The average age of group A was 68.3 years and group B was 72 years, the mean duration was 27.4 months and 26 months, respectively. Intermittent claudication was 8 cases and 16 cases respectively, and rest pain both was 4 cases, foot ulcer was 1 case and 4 cases, toe gangrene both was 3 cases. Ankle Brachial Index (ABI)≤0.4 was 2 in group A and 8 in group B, ABI>0.4 was 12 and 16, ABI=0 was 2 and 3, respectively. Excision with protective devices in 6 cases. Nine cases and 17 cases received treatment for proximal and distal lesions over the same period, respectively, included the proximal iliac artery stenting 1 case in group A and 5 cases in group B, distal calf arteries stenting 6 cases in group A and 11 cases in group B, balloon angioplasty 2 in group A and 1 in group B. Endpoints included postoperative mortality or amputation of target limb.
  
  
  RESULTS
  Forty-one operations were successful, the technical success rate was 95.3%, one case in group B suffered above-knee amputation. The target vessels of 41 patients maintain patency after discharge. Postoperative claudication distance increased to 500 meters except for one case in each group, all 4 rest pain patients got alleviated, reduced toe ulcer area happened in 1 and 2 cases respectively, all 3 cases of gangrene dried up/infection controlled in each group. Postoperative ABI result 0.7-0.8: 4 in group A and 5 in group B; 0.81-0.9 was 5 and 8; >0.91 was 6 and 13, respectively. Symptom improvement result had no significant difference between the two groups (P>0.05). Follow-up covered 41 patients, average 17.5±3.3 months. Group A patients stayed in good condition, 7 claudication patients's walking distance above 500 meters remains; rest pain no recurrence, one ulcer healing, 2 of 3 toe gangrene self-shedding and stump healing, 1 toe gangrene removed by surgery and wound healing. Group B, 4 of 15 claudication cases recurrence, and received plaque excision again. Rest pain no recurrence. 3 of 4 ulcer healing, 1 ulcer area reduced significantly. One out of 3 gangrene received below knee amputation (toe osteomyelitis), wound healing. One recurrence, angiography showed in-stent severe restenosis, received plaque excision again. One toe gangrene removed by surgery and wound healing.
  
  
  CONCLUSIONS
  Plaque excision with "SilverHawk" treatment for lower limb ischemia of atherosclerosis or in-stent restenosis is safe and effective. No significant difference for these two lesions in efficacy. Long term follow-up and larger randomized study is needed for further information on treatment.
authors.affiliation: Vascular Surgery Department of Xuan Wu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China. guyq66@yahoo.cn
authors.forename: G
authors.initials: G
authors.lastname: Yongquan
authors.forename: G
authors.initials: G
authors.lastname: Lianrui
authors.forename: Q
authors.initials: Q
authors.lastname: Lixing
authors.forename: L
authors.initials: L
authors.lastname: Xuefeng
authors.forename: T
authors.initials: T
authors.lastname: Zhu
authors.forename: C
authors.initials: C
authors.lastname: Shijun
authors.forename: W
authors.initials: W
authors.lastname: Yingfeng
authors.forename: G
authors.initials: G
authors.lastname: Jianming
authors.forename: Z
authors.initials: Z
authors.lastname: Jian
authors.forename: W
authors.initials: W
authors.lastname: Zhonggao
mesh_terms: D000368:Aged; D000671:Amputation, Surgical; D055109:Ankle Brachial Index; D017073:Atherectomy / Q000009:adverse effects / Q000295:instrumentation*; D050197:Atherosclerosis / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D003251:Constriction, Pathologic; D004691:Endarterectomy; D004867:Equipment Design; D005260:Female; D006801:Humans; D007383:Intermittent Claudication / Q000209:etiology / Q000601:surgery; D007511:Ischemia / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D007871:Leg Ulcer / Q000209:etiology / Q000601:surgery; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D058226:Plaque, Atherosclerotic; D020127:Recovery of Function; D012008:Recurrence; D012086:Reoperation; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D062666:Vascular Access Devices; D014945:Wound Healing